The epidemiology, treatment, and outcome assessment of neonatal brachial plexus palsy continue to be refined. Foad et al.1 analyzed the Kids' Inpatient Database from 1997, 2000, and 2003 to determine the incidence of neonatal brachial plexus palsy in the United States and additionally to determine the risk factors associated with brachial plexus palsy. In the United States, the incidence was at least 1.51 ± 0.02 cases per 1000 live births, but it decreased over the study period. The identified risk factors were shoulder dystocia (100 times increased risk), exceptionally large birth weight (4.5 kg) (fourteen times increased risk), and forceps delivery (nine times increased risk). On the other hand, twin or multiple births and cesarean section delivery appeared to have a protective effect. There appeared to be other unknown factors that influenced the incidence of brachial plexus palsy as only 46% of all children with this condition had one or more of these risk factors. In fact, 56% of brachial plexus palsies were not associated with a difficult delivery. Finally, the only reliable predictor of shoulder dystocia was a previous episode of shoulder dystocia in the mother.